Health care professionals are accustomed to measuring and refining their skills throughout their careers. According to leading health care ministry ethicists, the expectation for ongoing skills assessment and improvement extends equally to the practice of ethics because carrying out the healing mission of Jesus is fundamentally an ethical endeavor.
Still, the quality of ethics is sometimes uneven across the ministry, said Ron Hamel, a CHA senior director of ethics. A just released tool from CHA and Ascension Health offers methods for evaluating existing programs and a road map for improving them.
Hamel said that a few years ago, CHA's Theologian and Ethicist Committee recognized that there was a varying understanding across the ministry of what constitutes an effective ethics program and the level of commitment needed to deliver it.
A committee work group made up of CHA staff ethicists and representatives from five Catholic health systems set out to write standards and identify core competencies and components necessary for high-quality clinical and organizational ethics programs.
Around the same time that work group was getting started last summer, Ascension Health was convening its ethicists to launch a similar venture. John Paul Slosar, Ascension Health's senior director of ethics, said that the St. Louis-based system wanted to develop a framework for ensuring that everyone in its ministry is equipped to provide the highest level of ethics services.
Slosar explained that at the staff level, ethical competency can mean simply identifying when an ethical issue is present and should be addressed. At the ethics committee level, it can mean knowing how to structure policies and education programs that support an ethical culture. At the leadership level, it can mean ensuring that everyone in the organization understands ethics is a management priority.
Rather than duplicate the work, Ascension Health and CHA combined efforts. The result is a practical tool kit aimed at ministry ethicists, ethics committees and mission leaders intent on raising the visibility and caliber of clinical and organizational ethics in their ministries.
The tool kit is a resource available free exclusively to CHA members. It includes a booklet "Striving for Excellence in Ethics: A Resource for the Catholic Health Ministry" that contains recommended quality standards, an assessment tool, and a companion website. CHA members will be able to download the brochure and assessment tools from the website in mid-August. As Catholic Health World went to press, it was expected that the printed brochure would be ready for distribution around the same time. It can be ordered online through the CHA service center.
Hamel said the ethics resources are a piece of a much larger project to create an ethics training curriculum with the goal of raising the quality of ethics programs across the ministry. Hamel and Fr. Thomas Nairn, a CHA senior director of ethics, are collaborating with other ministry ethicists on the larger project, which has an initial time line of 18 months. The curriculum likely will include online and face-to-face instruction.
Hamel would like CHA members to send him ethics education modules they use to train ethics committee members and make these modules available to the entire ministry. If this is not possible, CHA may develop a set of modules, Hamel said.
Tools for tuning an ethics program
Practically speaking, many hospitals and small health systems lack the resources to support a staff position for a PhD-trained ethicist. Hamel said the majority of ministry providers rely on mission leaders and/or ethics committees comprised of clinicians and social workers to do their ethics-related work. The ethical knowledge base of individuals engaged in ethics in the ministry varies widely.
The guidelines for building excellence in ethics emphasize the importance of formation for lead ethicists and ethics committee members and stress that it is important to know when and how to seek outside advice.
The booklet contains an instrument for assessing components deemed essential to successful ethics programs as well as recommended quality standards for each of these components. The website contains about 75 tools including resources that may be useful in improving components of ethics programming or management, Hamel said. The resources are from Ascension Health; SSM Health Care, St. Louis; CHRISTUS Health, Irving, Texas; Catholic Health East, Newtown Square, Pa.; and other Catholic health systems. CHA members will be able to add information and resources to the tools going forward.
The web resource includes links to the recently revised edition of "Core Competencies for Health Care Ethics Consultation" produced by the American Society for Bioethics and Humanities, and to "IntegratedEthics," the U.S. Department of Veterans Affairs' National Center for Ethics in Health Care's system-focused model for improving ethics programming in health care.
While components of the secular ethics guides may be useful in shaping ethics programs in Catholic facilities, Ascension Health's Slosar said the ministry collaboratively built its own ethics practicum because the practice of Catholic ethics departs from secular ethics in fundamental ways.
An organization like the VA or the American Society for Bioethics and Humanities are not going to be concerned with the Ethical and Religious Directives for Catholic Health Care Services, Slosar said.
Too, the hierarchy of principles and values in secular ethics differs from that in Catholic ethics. For example, secular medical ethics gives a higher priority to the value of autonomy than Catholic ethics does, and Catholic ethics gives a higher priority to human dignity, Slosar said. In many views of secular ethics, ethics is relative to individual autonomy. Or, as restated by Slosar, "What is right for me may not be right for you."
In contrast, Catholic ethics hold that there is objective moral truth, he said. In the Catholic tradition, protecting human dignity and the common good may outweigh a patient's right to choose in certain circumstances. "In the case of Catholic ethics, an action may be right or wrong, whether I like it or not," Slosar said. For example, physician-assisted suicide or abortion would not be sanctioned by Catholic ethical standards.
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